Step2 CS Training in Alcohol Addiction and the Medical Consequences of Alcohol This project will create a website, WebOSCE.com, to provide a unique training opportunity for medical students to: 1) prepare for the USMLE(R) Step 2 CS (Clinical Skills) examination, and 2) learn and practice necessary clinical skills to interact with patients at risk or with an alcohol use problem. Significance: Alcohol use is a widespread public, social, and personal health problem, yet screening for alcohol use is straightforward, intervening is cost-effective, and effective treatment options exist. Many medical school curricula are inadequate and do not prepare students for proper assessment, intervention, and follow-up treatment of those with alcohol use disorders. Instead, students often develop approaches and attitudes that may, in fact, hinder future efforts to develop the skills they need in their clinical care of patients. This proposal utilizes the high motivation attached to Step 2 CS test preparation (and the need to actually develop and demonstrate clinical skills) to address this weakness. [[The WebOSCE approach can be applied during later states of training (internship/residency/fellowship) or practice (continuing professional development, specialty certification, and maintenance of certification). The approach can also be applied to other health professional trainees and eventually to other topics of interest to our users during Phase III.]] Innovation: The WebOSCE.com training experience will occur via a web-based interface including two components: a simulated Electronic Medical Record (sEMR) and a Remote (web-based) Live (real person in real time) Standardized Patient (RLSP) interview which occurs via Internet chat. This sEMR/RLSP hybrid allows the learner to query the sEMR and RLSP actor, request additional data from the sEMR (history, consults, laboratories, physical findings), build a differential diagnosis, and convey diagnostics choices, including treatment plans, to the RLSP. Innovation is demonstrated via: 1) focus on clinical skills and achieving clinical competency, 2) motivation of passing a test to address an educational need that is often ignored, 3) the sEMR/RLSP hybrid, and 4) tailored training and specific feedback to guide improvement. Investigators: The investigators and company have expertise developing, deploying, and supporting web- based training for medical students and other health providers on several addiction topics, including alcohol. Approach: Using examples of patients with or at risk for alcohol misuse, the project strives to improve proficiency in Association of American Medical Colleges (AAMC) core competencies including the application of scientific knowledge, patient engagement and communication, and patient care-related objectives. Phase I will modify and enhance existing RLSP cases. To provide a scalable and cost-effective solution, Phase I will also adapt our existing Drupal-based software to support a novel peer-education and rating system that 1) delivers an sEMR/RLSP experience to students, 2) helps rate student's performance, 3) trains students so they can perform the role of RLSP for each other, and 4) schedules RLSPs with learners. PUBLIC HEALTH RELEVANCE: Alcohol use disorders continue to be a growing problem in the United States; 52% of Americans consume alcohol on a regular basis (SAMHSA, 2010) and approximately 6% of those users meet the criteria for alcohol abuse or dependence (SAMHSA, 2005), or 3% of the total U.S. population. Physicians, and other health care providers, are in a unique position to counsel and treat those who abuse alcohol and lessen the medical consequences of alcohol use; unfortunately future physicians and other health care providers are often not given the skills to interact with patients to assess those with alcohol use disorders, and provide counseling and treatment options. This project offers a unique and novel solution to the training needs by taking advantage of the common need, and high anxiety, associated with preparation for the USMLE Step 2 CS (Clinical Skills) examination which is required for medical licensure in the United States.